Posted
by
kdawson
on Tuesday November 14, 2006 @01:39PM
from the I-can-top-that-one dept.

lizzyben writes, "Baseline has a major story about a major IT disaster in the UK: 'In 2002, the English government embarked on a $12 billion effort to transform its health-care system with information technology. But the country's oversight agency now puts that figure at $24 billion, and two Members of Parliament say the project is "sleepwalking toward disaster"... In scale, the project... (NPfIT) is overwhelming. Initiated in 2002, the NPfIT is a 10-year project to build new computer systems that would connect more than 100,000 doctors, 380,000 nurses and 50,000 other health-care professionals; allow for the electronic storage and retrieval of patient medical records; permit patients to set up appointments via their computers; and let doctors electronically transmit prescriptions to local pharmacies.'" An Infoworld article from earlier this year sketches some of the all-time greatest IT meltdowns.

When doesn't government go overbudget? Government is the combination of bureacracy, inefficiency, monopoly use of force and the free use of other people's money. Government agencies can never do anything under budget because if they do, they'll see their budgets cut. Each department of an agency is required to work just a little beyond budget since that is how government grows: "we only need a little more money/staff/time." Since each department does this, each agency of departments has bigger and bigger needs leading to more and more inefficiencies.

When a competitive free market group of companies goes after work, they have to balance their profit versus their ability versus the good use of their time. If you bid a job and win it, there's no going back and asking for more. For big projects that my companies do, we get bonding insurance for double the bid package -- this protects our customers from our failures. Government, on the other hand, doesn't need bonding insurance: they just go and get more money in the form of various user fees, taxes, tariffs and inflationary fiat currency.

We should not be surprised here, either, since it is a health-care market. In the U.S., health care costs have skyrocketed since government has destroyed the free market of health-care provisions. The law provides write-offs for businesses that offer health insurance, but individuals don't get that write-off, so health insurance is pushed onto the company which incurs additional overhead. We also see people using insurance for basic healthcare costs, which means that insurance companies spend money on non-emergency situations, so the cost goes up. Combine that with the AMA's fraudulent restrictions on the number of graduating doctoral students and you see a limited supply of available doctors (cost goes up when supply goes down), and then throw in the bureacracy of Medicare and the price skyrockets. England is worse, since they are (I believe) a cover-all insurance scheme.

Imagine if we all went to dinner and had to pay our own meals. We'd all get what we could afford -- burgers for some, steaks for others, soup for the few. Now imagine if we decided to split the bill equally. At first, we'd still buy what we used to, but some people would realize they could now afford steaks for just a little more cash out of pocket. When other people subsidize your irresponsibility, you become irresponsible. Eventually, everyone's buying steaks -- and all our costs go up. In government-run healthcare, everyone orders steaks, but the added bureacracy means the costs are well over the average steak -- and everyone expects to pay for soup.

The toss in IT run by government, and you have a history and a future of ineptitude, inefficiency, lack of competition to drive down costs, and the rest.

I'm not even sure what the point is of this IT upgrade. What exactly do they need this system for? Doctors work fine with paper charts and files -- this is a ridiculous amount of money -- what is the benefit and how do the costs make the benefit still beneficial?

As I said before... duh.

Sidenote: One of my lady's best friends runs a huge network for a hospital chain that is in the process of combining with another hospital. She's told me repeatedly that the biggest costs for her MIS department is integrating all the bureacratic changes that the government requires -- paperwork, forms, etc. While she's a big-government Republican (the new style), she is blown away that 80% of her staff deals with those headaches, which are constantly changing and always need more people to do the job. It disgusts me.

Things here in the UK always seem to be thought of as failing or disaster before they're completed. I'm sure we hate success as a nation. We also have a huge obsession with celebrity and magazines that publish how fat celebrities are, or how their lives are in a mess always do very well.

I say wait until the project's finished before kicking it to the ground.

'In 2002, the English government embarked on a $12 billion effort to transform its health-care system with information technology. But the country's oversight agency now puts that figure at $24 billion

I imagine if you're the company getting paid the $24 billion, the project is a tremendous success.

Four years, a couple of trips to hospital, and more than a handful of GP appointments and this is the first I've heard of it. Way to go, NHS(!).
Perhaps a better way to spend $24m (or whatever that is in £real money) would have been to keep my local emergency department open, rather than sending me on a half-hour trip to the next nearest hospital...

Either way, I'm not sure how things work in the UK but in the US, if WebMD were to suddenly gain the US Government as a customer, the government would require that WebMD suddenly adapt to a bunch of contractor regulations that they probably aren't following at the moment.

Plus, politicians could put one of two things on their campaign fliers: "...and strongly worked to get our great nation a site license for WebMD" or "...and strongly worked to build the national physicians communication network" or some such.

and see if getting a metric ton of vendors to make their various bits all work together in some new way to deploy mega-healthcare infrastructure gets close to working. One vendor typically does not want to know or care to know what the others are doing which makes for lots of daily progress.

Oh wait, then there's the legacy system vendors.

Easy, in fact, too easy to take shots at programs like this.

They stand such a high rate of failure that incremental change should have been adopted in the first place. The politicians behind this one have all disowned the project by now I'm sure.

The word "overarching" comes to mind whenever I hear about projects like this. If there's anything my years in software and systems has taught me, it's that starting with a monolithic design will mean monolithic failure. You invariably end up with too many cooks, all working on Lord knows what, accomplishing a very expensive nothing. There's just too much coordination to maintain any semblence of progress.

In fact, the most successful large scale projects always seem to be grown out of combinations of smaller architectures rather than a single massive architecture. Look at the Internet for an example. The protocol was architected. The routing design was architected. The information delivery systems were architected. The network itself? Grown with tender loving care, and Lots'o'peering agreements.

If you want to solve an issue like modernizing Hospital IT, start small and work your way up. Design each technology independently, but not monolithically. Keep an eye toward standards rather than specific implementations. (Standards will allow you to plug in a few competing implementations, giving you "best of breed" options.) Then use those technologies to build out a few test sites. Work out the kinks, then start deploying at a few more sites. Keep doing that, and the economics of scale will begin to take hold. (i.e. The more you do of something, the less expensive it gets to do it.) With any luck, the project will get done within a reasonable budget and timeline.

In late September, Accenture, the global management and technology consultancy

And excellent steak analogy, but you forgot to include the circumstances that prompt the need for a government managed health care system in the first place -- what happens when the restaurants sell so many burgers and so few steaks that they need to manipulate their pricing structure until those burgers become the price of steaks? Or when they decide to just stop serving burgers entirely and choose instead to offer a 'name brand equivalent' like maybe some ground buffalo, which tastes just the same, but costs a whole lot more? And what happens to the individuals who desperately NEED those steaks but can only afford a small side salad? There's a big difference between 'subsidizing irresponsibility' and sharing costs to help treat people with terminal and degenerative diseases who are incapable of generating a full-time income.

It never ceases to amaze me that there are people who will apply the "pull yourself up by your bootstraps" mentality to those suffering from Muscular Dystrophy, ALS, Leukemia and all of those others afflictions that obviously afflict far more than just the 'lazy' and 'irresponsible'. Is this compassionate conservatism in action?

When projects like this get going and the emphasis should be on subject matter experts (SME), the projects usually get expendable high-level highly paid deadweight -- I've seen it too many times.

I think you've hit the nail on the head with this statement. The government made a poor decision on who should run the project and he, in turn, made quite possibly the most bone-headed decisions he could possibly make.

From the article:

Granger commissioned the management consulting company McKinsey to do a study...[that]... concluded... that no single existing vendor was big enough to act as prime contractor on the countrywide, multibillion-dollar initiative the NHS was proposing....The result: He divided England into five regions--London; Eastern; Northeast; Northwest with West Midlands; and Southern--each with a population of about 10 million.

That last sentence made my jaw drop. How someone in his position could so blatantly avoid consulting anyone with any technical acumen is beyond me. Yes, it's possible, that no single vendor was capable of creating such a system alone. But the vast majority of a project like this is about creating a single process for every use case that the system is designed to handle. As such, the project shouldn't ever be broken down into groupings like number of patients in the system. Computers are great at handling really large numbers when the software is designed up-front to scale to really large numbers. The system should have been broken down into separate processes for which individual vendors would handle that single process (or grouping of processes) for everyone in the country.

The X-Ray example is a perfect one. Why would anyone in their right mind have 5 separate vendors all attempt to implement a solution for the problem that was only applied to the region they managed? At best, one region would end up with a solution that was better than every other region. However a competant management decision would have been to look for a vendor that could handle *only* the process of integrating the country's X-ray facilities with the country's high-speed data network. Another vendor would be responsible for supplying and maintaing that network. Still another vendor would be responsible for maintaining the huge data center (or centers) where information was housed. Just off the top of my head, GE could be responsible for the X-Ray integration (I know they have the necessary expertise), BT could handle high-speed network (among others, but why use foreign expertise when a UK company could handle it). And there are any number of competant vendors that could handle a high-availability server environment with a massive database.

Basically, had they had anyone with have an ounce of technical acumen, they would have devided the project up along functional boundaries of the application rather than regional boundaries of the country. That way, even if some of the projects went horribly over-budget, at least some of the project would be useful. Now, because of the inept management decisions, the whole thing is a train wreck.

You forget. The compassion in compassionate conservatism is the lovely warm feeling one gets in one's heart when scattering breadcrumbs at Christmas to those poor, adorable, starving orphans.

Charity will help out the most needy, remember?

Fuck anyone who's suffering from an unfashionable or distasteful illness; they only brought it upon themselves. The good old mom-and-pop doctor will solve everything else - that's what capitalism is for!

I'm sorry but did you even take time to read the article? I ask because you make statements about saying stuff like this: When a competitive free market group of companies goes after work, they have to balance their profit versus their ability versus the good use of their time. If you bid a job and win it, there's no going back and asking for more. But that's exactly what the article talks about. Accenture was the prime, or at least had the majority of the contract and they screwed up spent a lot of the governments money and quit .

Then you talk about universal health care? What does that have to do with TFA? If I had to guess I would just say you read the title and picked out some of your favorite arguments that had nothing to do with TFA and strung them together to get a +5 insightful. Congradulations you know how to play to the mindless sheep.

My proposition: So, you go out skiing and screw up your knee. Doctor pops a brace onto it and sets you up for a specialist, who recommends scoping the knee, fixing it, and a physical therapy regimen. How long until you get surgery in Canada.

His answer: 6 months.

If I wasn't out of physical therapy inside of 6 weeks I'd be finding someone to sue.

Our system in the US is way more expensive. It also works, it works quickly, and people don't go without. We don't let people bleed out in an ER because they don't have insurance. That's ILLEGAL, in addition to any moral/ethical issues. It'll flat get people thrown into jail. Stories of those things happening are either made up or they don't include the "oh, then the attending physician in the hospital went to PMITA prison for 20 years" endings.

Do we want to make our system more efficient? Yeah. How? By reducing government in it, not increasing it. By reducing the sheer volume of paperwork required to get payment from an insurance company, paperwork required by the feds, oh, unless it's a medicare claim, in which case the paperwork is significantly less. Yes, less. Why? The government doesn't have the time or personnel to handle the paperwork, but they force private insurers to do it. If medicare was held to the same standards as your insurance company and had to live within the same liability framework, medicare would be even more untenable than it is.

You're comparing purposefully designed flaws done by the CIA with Microsoft incompetence? THat's kind of a stretch.

More importantly, perhaps, was the fact that the CIA was also screwing with the HARDWARE at a manufacturing level.

Frankly, your entire argument doesn't make sense at any level. If the Soviets had the people to check the software in-house, it would have been far more reasonable and realistic for them to make the software in-house too. Instead, the entire REASON the KGB was stealing this software was because they COULDN'T develop it themselves.

For god's sake, the KGB was stealing American technology and the CIA introduced purposeful bugs to counter them. That's got abso-fucking-lutely nothing do to with IT and everything to do with spycraft.

Only an absurd zealot would be in able to connect that somehow to Microsoft being bad.

get this - Halliburton *has* a UK division, and they are actually the main project management company responsible - they received all the cash from the UK government, and are responsible for handing out the money to the subcontractors that build the various systems. I have been involved in the past in several different aspects of the tendering and scoping of parts of this project. It outright disgusting

> If, as you maintain, more government == more disaster wouldn't it stand to reason that these socialist model health systems would be doing worse than the US system?

Only if they truly have more government. If you look at total cost of government there really isn't any nation in the world which is as expensive as the US. If you diligently keep track of your taxes--on your paycheck, at the cash register, at the pump, extras for sin taxes and luxury items, real estate, utilities, taxes on shipping which you indirectly pay in the cost of the products that you buy, on and on for every little nickel and dime hidden tax--you'll find that nearly 70% of total annual income for the average American is returned to the government over the course of the year.

Most of the socialist nations don't come anywhere near to taxing their citizens this much. The US truly has the most government and, therefore, the most bureaucratic disaster.

The law provides write-offs for businesses that offer health insurance, but individuals don't get that write-off, so health insurance is pushed onto the company which incurs additional overhead. We also see people using insurance for basic healthcare costs, which means that insurance companies spend money on non-emergency situations, so the cost goes up.

They are trying to change this here in the United States by introducing the tax deductible health savings account, which is a step in the right direction but not completely effective until the government ABOLISHES the tax deductible benefit of employer provided health care. You see right now there is little incentive for the consumer to seek his own health care coverage in the open marketplace because the employer provided plan is a tax deduction already, meaning that the employee does not pay tax on his employer plan premiums, albeit with lower quality HMO care (but most people don't understand the difference until their life saving cancer treatment is denied as 'too expensive' by the insurance company at which point they raise holy hell, but hey you get what you pay for right?). The health savings accounts will not be effective in reducing costs, through market forces, until consumers are fully incentivized to take advantage of them.

We also see people using insurance for basic healthcare costs, which means that insurance companies spend money on non-emergency situations, so the cost goes up.

This is exactly right. The health care insurance industry is peculiar in that they pay SOMETHING on just about EVERYTHING and this serves to promote over consumption and drive up costs. One does not insure their home against the cost of mowing the lawn or their car against the cost of replacing worn parts, but rather against accidental serious, catastrophic, or total loss. The health care insurance industry should not be any different. If people used the health savings account and then paid out of pocket from their savings in the account then the prices would be well controlled by the market forces of people seeking out the best deal on perscription drugs, routine office visits, and other forms of routine non-emergency care.

Combine that with the AMA's fraudulent restrictions on the number of graduating doctoral students and you see a limited supply of available doctors (cost goes up when supply goes down), and then throw in the bureacracy of Medicare and the price skyrockets.

This is one problem that we don't have here in the United States because there are no government regulations controlling the number of people who chose to go to medical or nursing school. In the United States, provided that one is wealthy enough to afford the costs education or able to borrow the money, anyone who meets the necessary qualifications can attend medical school and be subsequently licensed as a practitioner in their home state of choice. The British people have some funny ideas about what should and should not be regulated and/or taxed, but that is another discussion entirely.

England is worse, since they are (I believe) a cover-all insurance scheme.

I think that in many ways the United States is actually worse and NOT because I think that the single payer government provided health care system is the way to go because clearly England has had major problems with the system. However, there is one bright spot, from a cost standpoint anyway, in the British system and that is the ability to ration care. If the government controls all health care payments in the public system then they can control costs by rationing care and/or denying treatments at the probable expense of public frustration and anger. In the United States not only can we NOT ration care since the health care system is not directly controlled by the government, but we create incentives for hospitals, lawyers, and insurance companies to escalate costs while removing any individual incentives to seek better priced and better quality ca

I've also read that the pot-in-pot refrigeration allows children to go to school, as they don't have to go to market to hawk their families produce everyday. The technology didn't make the creators all that wealthy, but everybody who uses it is hugely better off; in fact, more 'wealthy'.

Personally, I think the most universal measures of 'good' are wealth and self determination(freedom, liberty, whatever). A man who wakes up in the morning secure in his person, health and future has it all. The rest is just details; capitalism turns out to be a pretty good way to allocate resources(it rewards success, which is as good a way as I can think of to create more success.), and education tends to be a pretty good thing too, because it makes people more able to become self sufficient.

The entire rationale behind Choose and Book is fallacious. It's a piece of window dressing for government policy - a service rooted in spin. The premise that "Patients want to choose which healthcare service to consume." is utter nonsense.

Patients in the UK, by and large, do not want to choose. They just want to receive treatment. Because of the prevalence of the NHS, and the relatively low takeup of private healthcare, there is no real perception of choice anyway.

Making the patient choose a service provider is just a means for the government to impress upon the populace that they are making changes to NHS IT systems. Choose and Book is a convenient example because it contains no potential compromise to patient confidentiality, and because it's a relatively easy project.

If it had been done properly, of course, people would barely know it was there. Things would proceed as they always had done - the doctor would use his judgement (which is far better informed than the patients), select a specialist to refer to, and use the system to place the referral. In short, it would be a streamlined replacement for an existing paper system. Of course, this is not a high profile, visible success for government IT policy.

PS ; My opinion as expressed in any public forum in no way constitutes an accurate or informative reflection on the actual motivations for government policy.